Organ and bone marrow transplants are among the most complex and costly events across the health care industry. Transplants performed in the U.S. continue to increase each year, with 2025 achieving a record for total organ transplants.[1]
As patient complexity, expanded donor utilization, organ preservation technologies, and procurement logistics continue to evolve, transplant costs and operational complexity are increasing across the healthcare system.[2] By introducing significant financial risk and clinical variability, transplants underscore the need for a proactive, strategic approach. One of the most effective, yet often overlooked, strategies for managing rising transplant costs is proactive transplant contracting.
This article outlines the role of transplant contracting in managing high-cost claims, examines the key drivers of cost variability, and highlights strategies to improve claim predictability while supporting optimal clinical outcomes.
National data show that average billed charges for a transplant period range from approximately $470,000 to over $1 million, depending on organ type, complications, and center pricing behavior.[5] Paid amounts, however, vary dramatically based on whether a transplant-specific contract is in place, even when services are clinically similar. Cost variation can be driven by:
Where care is delivered and how it is contracted significantly influences total claim cost. Specialized transplant contracting strategies, including transplant carve-outs and Centers of Excellence network arrangements, can improve cost predictability and often provide additional savings of 10%–30% beyond standard PPO discounts, particularly for high-cost or out-of-network cases. These strategies can be especially valuable for self-funded employers, TPAs, captives, and regional health plans seeking greater financial protection and consistency in managing catastrophic transplant risk.[4]
“In 2025, liver transplants reached a record high, increasing 8% year over year compared to 2024.”
For employers, even when a large national TPA or network is involved, the selected transplant facility may not be contracted with that network. Ensuring that a Single Case Agreement (SCA) is negotiated when needed can be critical to controlling costs and minimizing financial risk.
Unlike traditional hospital agreements, transplant contracts often span the full treatment of care, from evaluation, organ acquisition, surgery, inpatient recovery, and post-transplant follow-up.[6] Without a defined transplant contract, reimbursement may default to different methodologies across each phase of care, increasing exposure to unanticipated costs.[7]
Effective transplant contracts clearly define the financial boundaries of care, including:
These elements help keep costs from rising after the transplant starts, when payers have little leverage.
Across national transplant networks and payer analyses, contracted transplants consistently result in significantly lower paid claims compared to non-contracted care, often reducing costs by 50% to 65% versus billed charges. Our experience has shown similar results, reinforcing the value of early contracting and network alignment.
“Clients using PULSE + Plus® network evaluation and placement services achieve average savings exceeding 50% across most transplant types.”
These savings extend beyond simple unit price discounts and are often driven by more predictable episode pricing, fewer unbundled charges, improved care coordination, and more consistent length-of-stay management. Together, these factors improve cost predictability in some of the highest-volatility claim areas and support stronger underwriting confidence and reserve accuracy.
Risks Without a Transplant-Specific Contract
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Network Matters
Centers of Excellence and established transplant networks often deliver stronger care coordination, more consistent pricing, and access to experienced, high-volume programs. Outcomes data through the Scientific Registry of Transplant Recipients and our contracted networks also provide transparency into patient and graft survival outcomes, helping support informed contracting decisions focused on both quality and cost predictability.
Early Engagement Is Key
Contract placement prior to transplant meaningfully influences total cost of care, facility access, and overall claim trajectory. Once care begins, pricing leverage decreases significantly. While retrospective review or negotiation may still be possible in certain situations, opportunities become more limited.
Early engagement, ideally during prior authorization, evaluation phase or prior to transplant admission can have a significant impact on cost containment, reimbursement strategy and provider access. This positions transplant contracting as a front-end risk management strategy rather than a retrospective cost control activity.
High Volume Programs Strengthen Value
Higher-volume transplant programs often offer more competitive contracting opportunities and are easier to evaluate through established outcomes data. Facilities that are performing higher are easier to identify, and certain access and administrative fees may decline.
While the financial impact is significant, transplant contracting also supports coordinated care delivery, improves access to experienced programs for complex cases, and may enhance clinical outcomes in high-acuity scenarios. The objective is not to steer care, but to ensure timely access to the most advantageous options available.
Alignment With Emerging Value-Based Payment Models
Emerging reimbursement models, including CMS’s Increasing Organ Transplant Access Model, are reinforcing the industry’s shift toward outcome-based accountability and episode-level cost management. Organizations with established transplant contracting strategies are better positioned to navigate evolving value-based reimbursement frameworks.
Early identification, contract evaluation, and rapid network placement can meaningfully influence claim outcomes. Through PULSE + Plus®, these activities supported more than 400 transplant referrals in 2025, both in employer stop-loss and reinsurance markets. As shown in Figure 1, kidney and liver referrals represented most cases, reflecting broader national transplant trends as chronic kidney disease and advanced liver disease continue to drive high transplant utilization.[8]
Figure 1: 2025 PartnerRe transplant referrals by type.
Whether you are an employer, payer, or broker supporting your clients’ risk management strategy, early engagement can help identify contracting opportunities before costs escalate. Even after the evaluation period or once care has begun, there may still be opportunities to reduce financial exposure through contracting and network placement. Contact our PULSE + Plus® team to explore transplant contracting and network placement strategies that may help optimize both clinical and financial outcomes.
Tina Anderson, MHA, RN, CCM, AVP Clinical Services, PULSE+Plus®, PartnerRe US Health
Marie Kopp, RN, MAOL, Clinical Consultant, PULSE+Plus®, PartnerRe US Health
[1] https://unos.org/media-resources/releases/u-s-surpasses-49000-organ-transplants-while-deceased-organ-donations-dip/
[2] Keeping Up with Technical Innovations in Organ Transplantation: Economics and Operational Costs (Part 2) | The Organ Donation and Transplantation Alliance
[3] www.optumhealtheducation.com/sites/default/files/120824_Changing_Art_to_Science–Evaluating_Transplant_Provider_Contracts.pdf
[4] Why Self-Funded Plans Should Carve-Out Transplant Services | OneDigital
[5] https://www.optumhealtheducation.com/sites/default/files/120824_Changing_Art_to_Science%E2%80%93Evaluating_Transplant_Provider_Contracts.pdf
[6] www.organdonationalliance.org/insight/transplant-contracting-considerations/
[7] https://campaign.optum.com/content/dam/optum3/optum/en/resources/white-papers/WF270672_Transplant_Risk_White_Paper.pdf
[8] www.sciencedirect.com/science/article/pii/S1600613524000790